The Better Health Services Project Signs Agreement to Provide Technical Guidance to all Cambodian Health Equity Funds

URC’s USAID Better Health Services (BHS) project has signed a Memorandum of Understanding (MOU) with Cambodia’s Ministry of Health (MOH) to provide technical support and monitoring of all health equity funds (HEF) in Cambodia. HEFs provide free access to public health services for an estimated 2.25 million poor Cambodians. They cover not only the direct costs of health services and medications for the poor but also reimburse patients for transport and their caretakers for food expenses during hospitalizations. In USAID-supported areas alone, HEFs have tripled the hospital services use rate by the poor, and that rate now exceeds that of the non-poor.

Cambodia's HEFs will expand in 2012 from the existing 43 Operational Districts to 58, out of the total 77 districts. Achieving national coverage by 2013 is one of the key goals in Cambodia's Second Health Sector Strategic Plan (HSSP2) and a major success for USAID. The graph illustrates the expansion of HEFs since their conception in 1999. URC, with funding from USAID, has been the primary supporter of HEFs since 2003, when only 6 Operational Districts were covered.

Graph 1: Number of Operational Districts covered by a full HEF increases.

BHS will continue to play a major role in the technical direction and independent monitoring of HEFs, covering all 58 Operational Districts where HEFs are operating in 2012. The new MOU calls for a focus on the independent monitoring of direct benefit distributions and the provision of technical assistance to the MOH. Key elements of this technical assistance include:

  • MOH/HSSP2 adoption of a Pay-for-Performance method of contracting for national NGOs that function as Health Equity Fund Operators at the Operational District level;
  • Establishing a standardized benefit package and provider payment mechanism for all HEFs;
  • Continued establishment of a standardized, robust independent monitoring system that verifies that direct benefits actually reach the poor;
  • Development of a Social Health Protection patient-level data system to manage membership in the HEF and that will be integrated with a national patient registration/medical record database;
  • Analysis and documentation of HEF-generated data made available through the national Health Management Information System.

The MOH is taking increasing ownership of the HEF program. Funding of HEFs in USAID-targeted provinces was initially completely dependent on the generosity of the American people. Starting in late 2007, URC negotiated with the MOH/HSSP1 project to share the costs of HEFs. Initially, the MOH/HSSP1 (&2) projects paid for the direct benefits provided to the poor while USAID supported the management costs. Starting in 2012, the Royal Government of Cambodia and the MOH/HSSP2 project will support all the direct benefit costs and the greater share of the management costs. BHS will continue to pay management costs in the areas where the Community Based Health Cooperative (CBHC) model is being piloted. The graph below illustrates the sources of funding for the direct benefits and management costs of HEFs in USAID target areas.

Graph 2: Cambodia's Ministry of Health increasingly assumes HEF costs.

April 04, 2012
Tapley Jordanwood, Health Financing Program Manager, Better Health Services
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